A Virtual Reality Simulation to Examine the Relationship Between Post-Traumatic Stress Symptoms and Decision-Making in First Responders.

First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD = .5.66) (F(1, 360) = 5.32, p = .02, partial η2 = .015). We found that TEs had a direct effect on EDM, ß = -.16, Z = -3.74, p < .001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, ß = .02, Z = 3.10, p = .002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed.

Stress Inoculation in Police Officers Using Virtual Reality: A Controlled Study.

Policing is a highly demanding and stressful profession. Virtual reality (VR) has emerged as a promising tool for enhancing stress management programs, including for police officers. The use of VR in combination with biosensors enables measurement of psychophysiological responses such as peripheral temperature (PT) and skin conductance level (SCL). This study investigated the psychophysiological responses of police officers exposed to a VR scenario simulating a car accident. The study included a total of 63 police officers from the Public Security Police. Participants were divided into three groups based on their police divisions: the Investigation Brigade of Traffic Accidents, the Traffic Surveillance Squad (TSS), and a control group from the Lisbon Metropolitan Command. The results indicated that the VR environment effectively induced psychophysiological arousal, particularly in less experienced officers (TSS), that is, there were significant group differences in mean SCL and PT, showing this group with higher SCL and lower PT during the VR exposure. These results support the potential of VR as a stress inoculation strategy for training police officers and highlight the complex nature of stress responses that are influenced by individual factors and psychopathology.

Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study.

AIMS: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. DESIGN, SETTING AND PARTICIPANTS: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. MEASUREMENTS: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. FINDINGS: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. CONCLUSIONS: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

Computerized cognitive training using virtual reality on everyday life activities for patients recovering from stroke.

PURPOSE: Recent studies argue that the use of virtual reality tasks depicting activities daily living may be effective means for cognitive rehabilitation. The aim of this study was to test an ecologically oriented approach in virtual reality resembling the demands of everyday life activities for cognitive rehabilitation following stroke. MATERIALS AND METHODS: The sample comprised 30 sub-acute stroke patients recovering from stroke in a rehabilitation hospital. They were assessed in a single-arm pre-post intervention study on global cognition, executive functions, memory and attention abilities. The intervention consisted of virtual reality in a multidomain cognitive training approach depicting everyday life tasks (preparing food, choosing clothes, shopping, etc.). RESULTS: Improvements were found in the assessed cognitive domains at 6 to 10 post-treatment sessions. In-depth analysis through reliable change scores has suggested larger treatment effects on global cognition. CONCLUSIONS: Overall results suggest that the use of virtual reality-based exercises on everyday life activities may be a useful cognitive rehabilitation approach to provide short-term gains in cognition following stroke.Implications for rehabilitationVirtual reality-based cognitive rehabilitation resembling everyday life activities may provide short-term gains in cognition of stroke patients;Consistent improvements in executive functions may require higher treatment dosage than for improvements in global cognition.

Is Pupil Activity Associated With the Strength of Memory Signal for Words in a Continuous Recognition Memory Paradigm?

Research on pupillometry provides an increasing evidence for associations between pupil activity and memory processing. The most consistent finding is related to an increase in pupil size for old items compared with novel items, suggesting that pupil activity is associated with the strength of memory signal. However, the time course of these changes is not completely known, specifically, when items are presented in a running recognition task maximizing interference by requiring the recognition of the most recent items from a sequence of old/new items. The sample comprised 42 healthy participants who performed a visual word recognition task under varying conditions of retention interval. Recognition responses were evaluated using behavioral variables for discrimination accuracy, reaction time, and confidence in recognition decisions. Pupil activity was recorded continuously during the entire experiment. The results suggest a decrease in recognition performance with increasing study-test retention interval. Pupil size decreased across retention intervals, while pupil old/new effects were found only for words recognized at the shortest retention interval. Pupillary responses consisted of a pronounced early pupil constriction at retrieval under longer study-test lags corresponding to weaker memory signals. However, the pupil size was also sensitive to the subjective feeling of familiarity as shown by pupil dilation to false alarms (new items judged as old). These results suggest that the pupil size is related not only to the strength of memory signal but also to subjective familiarity decisions in a continuous recognition memory paradigm.

Virtual Reality-Based Cognitive Stimulation on People with Mild to Moderate Dementia due to Alzheimer's Disease: A Pilot Randomized Controlled Trial.

The use of ecologically oriented approaches with virtual reality (VR) depicting instrumental activities of daily living (IADL) is a promising approach for interventions on acquired brain injuries. However, the results of such an approach on dementia caused by Alzheimer's disease (AD) are still lacking. This research reports on a pilot randomized controlled trial that aimed to explore the effect of a cognitive stimulation reproducing several IADL in VR on people with mild-to-moderate dementia caused by AD. Patients were recruited from residential care homes of Santa Casa da Misericórdia da Amadora (SCMA), which is a relevant nonprofit social and healthcare provider in Portugal. This intervention lasted two months, with a total of 10 sessions (two sessions/week). A neuropsychological assessment was carried out at the baseline and follow-up using established neuropsychological instruments for assessing memory, attention, and executive functions. The sample consisted of 17 patients of both genders randomly assigned to the experimental and control groups. The preliminary results suggested an improvement in overall cognitive function in the experimental group, with an effect size corresponding to a large effect in global cognition, which suggests that this approach is effective for neurocognitive stimulation in older adults with dementia, contributing to maintaining cognitive function in AD.

Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial.

BACKGROUND: Alcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce. OBJECTIVE: The aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs. METHODS: This study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility. RESULTS: In order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies. CONCLUSIONS: Overall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345.

Adaptive Non-Immersive VR Environment for Eliciting Fear of Cockroaches: A Physiology-Driven Approach Combined with 3D-TV Exposure.

Non-immersive VR environments are related to the least interactive application of VR techniques, such that interaction with the VR environment can occur commonly by 3D-TV without full immersion into the environment. This study presents how 3D-TV exposure combined with physiology recording can elicit fear of cockroaches among individuals with different levels of fear. Thirty-six participants, set apart into three fear groups (low vs. moderate vs. high), were exposed to VR environment with cockroaches for 4 minutes while recording and using cardiac activity as input to the VR environment. Results revealed significant effects on self-report measures and heart rate between different fear groups. Moreover, participants with higher levels of fear were more likely to trigger cockroaches into the scenario due to their cardiac acceleration. Overall results suggest that our physiology-driven VR environment is valid for fear elicitation while having potential use in therapeutic domain.

Los entornos de RV no inmersivos se constituyen en la aplicación de menor interactividad en relación con las técnicas de realidad virtual, de modo que la interacción con el entorno de realidad virtual puede ocurrir de forma común en televisores 3D (TV-3D), sin que exista una inmersión total en el entorno. Este estudio presenta cómo la exposición a la TV-3D, combinada con el registro fisiológico, puede inducir temor a las cucarachas en personas con diferentes niveles de miedo. Treinta y seis participantes, divididos en tres grupos según su nivel de miedo a las cucarachas, fueron expuestos a un entorno de realidad virtual con cucarachas, durante 4 minutos, mientras se registraba su actividad cardíaca, que fue usada como entrada para el entorno de realidad virtual. Los resultados revelaron efectos significativos en las medidas tomadas por autorreporte y en la frecuencia cardíaca de diferentes grupos temerosos a las cucarachas. Además, los participantes más temerosos son más propensos a desencadenar la aparición de cucarachas en el entorno de realidad virtual, debido a su aceleración cardíaca. Los resultados generales sugieren que nuestro entorno de RV es válido para inducir miedo a las cucarachas, con un potencial uso en el dominio terapéutico.

Virtual Reality-Based Cognitive Stimulation to Improve Cognitive Functioning in Community Elderly: A Controlled Study.

The advantages of using naturalistic virtual reality (VR) environments based on everyday life tasks for cognitive intervention in the elderly are not yet well understood. The literature suggests that the similarity of such exercises with real life activities may improve generalizability by extending the transfer of gains of training to everyday living. This study aimed to investigate the gains associated with this ecologically-oriented virtual reality cognitive stimulation (VR-CS) versus standard cognitive stimulation in the elderly. Forty-three healthy older adults were divided into two groups: an experimental group underwent a VR-based cognitive stimulation and an active control group underwent a paper-and-pencil cognitive stimulation. The outcomes assessed at the pre-treatment and posttreatment assessment consisted in well-established tests for cognitive and executive functioning, depression, subjective well-being, and functionality. The results showed positive outcomes on dimensions of general cognition, executive functioning, attention, and visual memory in the group that underwent VR-CS. Improvements in executive functioning in this group was supported by consistent evidence of increases in attention abilities but little evidence of increases in memory abilities. Both effects may have contributed to improvements in general cognition. Further studies are needed to test whether these effects may extend to well-being and functionality in cognitively impaired older adults.

Cognitive Stimulation of Elderly Individuals with Instrumental Virtual Reality-Based Activities of Daily Life: Pre-Post Treatment Study.

As the demographic structure in western societies ages, the prevalence and impact of cognitive decline rises. Thus, new solutions to tackle this problem are required. The use of Information and Communication Technologies (ICT)-based cognitive exercises has emerged in the last few decades, though with inconsistent results. Hence, we conducted a pre-post treatment study to further investigate this approach. We designed a set of virtual reality exercises that mimic activities of daily living by which the patient can train different cognitive domains. Twenty-five participants, ages 65-85, underwent 12 training sessions between the pre-treatment and post-treatment assessments. Significant increases were seen between the two assessments for some of the neuropsychological measures: visual memory, attention, and cognitive flexibility. Results also suggest that participants with lower baseline cognitive performance levels improved most after these sessions.

Performance on naturalistic virtual reality tasks depends on global cognitive functioning as assessed via traditional neurocognitive tests.

This investigation sought to understand whether performance in naturalistic virtual reality tasks for cognitive assessment relates to the cognitive domains that are supposed to be measured. The Shoe Closet Test (SCT) was developed based on a simple visual search task involving attention skills, in which participants have to match each pair of shoes with the colors of the compartments in a virtual shoe closet. The interaction within the virtual environment was made using the Microsoft Kinect. The measures consisted of concurrent paper-and-pencil neurocognitive tests for global cognitive functioning, executive functions, attention, psychomotor ability, and the outcomes of the SCT. The results showed that the SCT correlated with global cognitive performance as measured with the Montreal Cognitive Assessment (MoCA). The SCT explained one third of the total variance of this test and revealed good sensitivity and specificity in discriminating scores below one standard deviation in this screening tool. These findings suggest that performance of such functional tasks involves a broad range of cognitive processes that are associated with global cognitive functioning and that may be difficult to isolate through paper-and-pencil neurocognitive tests.

The Art Gallery Test: A Preliminary Comparison between Traditional Neuropsychological and Ecological VR-Based Tests.

Ecological validity should be the cornerstone of any assessment of cognitive functioning. For this purpose, we have developed a preliminary study to test the Art Gallery Test (AGT) as an alternative to traditional neuropsychological testing. The AGT involves three visual search subtests displayed in a virtual reality (VR) art gallery, designed to assess visual attention within an ecologically valid setting. To evaluate the relation between AGT and standard neuropsychological assessment scales, data were collected on a normative sample of healthy adults (n = 30). The measures consisted of concurrent paper-and-pencil neuropsychological measures [Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), and Color Trails Test (CTT)] along with the outcomes from the three subtests of the AGT. The results showed significant correlations between the AGT subtests describing different visual search exercises strategies with global and specific cognitive measures. Comparative visual search was associated with attention and cognitive flexibility (CTT); whereas visual searches involving pictograms correlated with global cognitive function (MoCA).

Affective and physiological correlates of the perception of unimodal and bimodal emotional stimuli.

BACKGROUND: Despite the multisensory nature of perception, previous research on emotions has been focused on unimodal emotional cues with visual stimuli. To the best of our knowledge, there is no evidence on the extent to which incongruent emotional cues from visual and auditory sensory channels affect pupil size. AIMS: To investigate the effects of audiovisual emotional information perception on the physiological and affective response, but also to determine the impact of mismatched cues in emotional perception on these physiological indexes. METHOD: Pupil size, electrodermal activity and affective subjective responses were recorded while 30 participants were exposed to visual and auditory stimuli with varied emotional content in three different experimental conditions: pictures and sounds presented alone (unimodal), emotionally matched audio-visual stimuli (bimodal congruent) and emotionally mismatched audio-visual stimuli (bimodal incongruent). RESULTS: The data revealed no effect of emotional incongruence on physiological and affective responses. On the other hand, pupil size covaried with skin conductance response (SCR), but the subjective experience was partially dissociated from autonomic responses. CONCLUSION: Emotional stimuli are able to trigger physiological responses regardless of valence, sensory modality or level of emotional congruence.

Cognitive Training through mHealth for Individuals with Substance Use Disorder.

BACKGROUND: Heroin addiction has a negative impact on cognitive functions, and even recovering addicts suffer from cognitive impairment. Recent approaches to cognitive intervention have been taking advantage of what new technologies have to offer. OBJECTIVES: We report a study testing the efficacy of a serious games approach using tablets to stimulate and rehabilitate cognitive functions in recovering addicts. METHODS: A small-scale cognitive training program with serious games was run with a sample of 14 male heroin addicts undergoing a rehabilitation program. RESULTS: We found consistent improvements in cognitive functioning between baseline and follow-up assessments for frontal lobe functions, verbal memory and sustained attention, as well as in some aspects of cognitive flexibility, decision-making and in depression levels. More than two thirds of patients in cognitive training had positive outcomes related to indicators of verbal memory cognitive flexibility, which contrasts to patients not in training, in which only one patient improved between baseline and follow-up. CONCLUSIONS: The results are promising but still require randomized control trials to determine the efficiency of this approach to cognitive rehabilitation programs for the cognitive recovery of heroin addicts.

Cognitive training on stroke patients via virtual reality-based serious games.

PURPOSE: Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages. In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation, a cognitive training program using virtual reality was applied to stroke patients. METHODS: A virtual reality-based serious games application for cognitive training was developed, with attention and memory tasks consisting of daily life activities. Twenty stroke patients were randomly assigned to two conditions: exposure to the intervention, and waiting list control. RESULTS: The results showed significant improvements in attention and memory functions in the intervention group, but not in the controls. CONCLUSIONS: Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation. Implications for Rehabilitation Improvements in memory and attention functions following a virtual reality-based serious games intervention. Training of daily-life activities using a virtual reality application. Accessibility to training contents.

Eye Movement Analysis and Cognitive Assessment. The Use of Comparative Visual Search Tasks in a Non-immersive VR Application.

BACKGROUND: An adequate behavioral response depends on attentional and mnesic processes. When these basic cognitive functions are impaired, the use of non-immersive Virtual Reality Applications (VRAs) can be a reliable technique for assessing the level of impairment. However, most non-immersive VRAs use indirect measures to make inferences about visual attention and mnesic processes (e.g., time to task completion, error rate). OBJECTIVES: To examine whether the eye movement analysis through eye tracking (ET) can be a reliable method to probe more effectively where and how attention is deployed and how it is linked with visual working memory during comparative visual search tasks (CVSTs) in non-immersive VRAs. METHODS: The eye movements of 50 healthy participants were continuously recorded while CVSTs, selected from a set of cognitive tasks in the Systemic Lisbon Battery (SLB). Then a VRA designed to assess of cognitive impairments were randomly presented. RESULTS: The total fixation duration, the number of visits in the areas of interest and in the interstimulus space, along with the total execution time was significantly different as a function of the Mini Mental State Examination (MMSE) scores. CONCLUSIONS: The present study demonstrates that CVSTs in SLB, when combined with ET, can be a reliable and unobtrusive method for assessing cognitive abilities in healthy individuals, opening it to potential use in clinical samples.

The Immersive Virtual Reality Experience: A Typology of Users Revealed Through Multiple Correspondence Analysis Combined with Cluster Analysis Technique.

Immersive virtual reality is thought to be advantageous by leading to higher levels of presence. However, and despite users getting actively involved in immersive three-dimensional virtual environments that incorporate sound and motion, there are individual factors, such as age, video game knowledge, and the predisposition to immersion, that may be associated with the quality of virtual reality experience. Moreover, one particular concern for users engaged in immersive virtual reality environments (VREs) is the possibility of side effects, such as cybersickness. The literature suggests that at least 60% of virtual reality users report having felt symptoms of cybersickness, which reduces the quality of the virtual reality experience. The aim of this study was thus to profile the right user to be involved in a VRE through head-mounted display. To examine which user characteristics are associated with the most effective virtual reality experience (lower cybersickness), a multiple correspondence analysis combined with cluster analysis technique was performed. Results revealed three distinct profiles, showing that the PC gamer profile is more associated with higher levels of virtual reality effectiveness, that is, higher predisposition to be immersed and reduced cybersickness symptoms in the VRE than console gamer and nongamer. These findings can be a useful orientation in clinical practice and future research as they help identify which users are more predisposed to benefit from immersive VREs.

Systemic Lisbon Battery: Normative Data for Memory and Attention Assessments.

BACKGROUND: Memory and attention are two cognitive domains pivotal for the performance of instrumental activities of daily living (IADLs). The assessment of these functions is still widely carried out with pencil-and-paper tests, which lack ecological validity. The evaluation of cognitive and memory functions while the patients are performing IADLs should contribute to the ecological validity of the evaluation process. OBJECTIVE: The objective of this study is to establish normative data from virtual reality (VR) IADLs designed to activate memory and attention functions. METHODS: A total of 243 non-clinical participants carried out a paper-and-pencil Mini-Mental State Examination (MMSE) and performed 3 VR activities: art gallery visual matching task, supermarket shopping task, and memory fruit matching game. The data (execution time and errors, and money spent in the case of the supermarket activity) was automatically generated from the app. RESULTS: Outcomes were computed using non-parametric statistics, due to non-normality of distributions. Age, academic qualifications, and computer experience all had significant effects on most measures. Normative values for different levels of these measures were defined. CONCLUSIONS: Age, academic qualifications, and computer experience should be taken into account while using our VR-based platform for cognitive assessment purposes.

Cognitive assessment of stroke patients with mobile apps: a controlled study.

Stroke is a major cause of cognitive impairments. New technologies such as virtual reality and mobile apps have opened up new possibilities of neuropsychological assessment and intervention. This paper reports a controlled study assessing cognitive functioning through a mobile virtual reality application. Fifteen stroke patients recruited from a rehabilitation hospital and 15 healthy control subjects underwent neuropsychological evaluation with traditional paper-and-pencil tests as well as with a pilot version of the Systemic Lisbon Battery (SLB). The criterion validity was the performance of stroke patients vs. healthy controls - which was lower both on the neuropsychological tests and on the SLB for patients. The pattern of correlations between neuropsychological tests and the SLB sub-tests for the respective dimensions showed overall moderate correlations in the predicted directions. We conclude that the SLB applications were able to discriminate the dimensions that they were designed to assess.

Executive functioning in alcoholics following an mHealth cognitive stimulation program: randomized controlled trial.

BACKGROUND: The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients. OBJECTIVE: Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence. METHODS: The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis. RESULTS: Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group. CONCLUSIONS: The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential improvements observed in frontal lobe functioning supports the use of mobile serious games for neuropsychological stimulation to overcome executive dysfunction in patients with alcohol dependence. This trial was negative on two neuropsychological/cognitive tests, and positive on one. TRIAL REGISTRATION: ClinicalTrials.gov NCT01942954; http://www.clinicaltrials.gov/ct2/show/NCT01942954.